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. 2018 Oct;156(4):1657-1664.
doi: 10.1016/j.jtcvs.2018.04.098. Epub 2018 May 3.

Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease

Jennifer M Lynch  1 , Tiffany Ko  2 , David R Busch  3 , John J Newland  4 , Madeline E Winters  4 , Kobina Mensah-Brown  4 , Timothy W Boorady  4 , Rui Xiao  5 , Susan C Nicolson  6 , Lisa M Montenegro  6 , J William Gaynor  7 , Thomas L Spray  7 , Arjun G Yodh  8 , Maryam Y Naim  9 , Daniel J Licht  4
Affiliations

Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease

Jennifer M Lynch et al. J Thorac Cardiovasc Surg. 2018 Oct.

Abstract

Background: Hypoxic-ischemic white matter brain injury commonly occurs in neonates with critical congenital heart disease. Recent work has shown that longer time to surgery is associated with increased risk for this injury. In this study we investigated changes in perinatal cerebral hemodynamics during the transition from fetal to neonatal circulation to ascertain mechanisms that might underlie this risk.

Methods: Neonates with either transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS) were recruited for preoperative noninvasive optical monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using diffuse optical spectroscopy and diffuse correlation spectroscopy, 2 noninvasive optical techniques. Measurements were acquired daily from day of consent until the morning of surgery. Temporal trends in these measured parameters during the preoperative period were assessed with a mixed effects model.

Results: Forty-eight neonates with TGA or HLHS were studied. Cerebral oxygen saturation was significantly and negatively correlated with time, and oxygen extraction fraction was significantly and positively correlated with time. Cerebral blood flow did not significantly change with time during the preoperative period.

Conclusions: In neonates with TGA or HLHS, increasing cerebral oxygen extraction combined with an abnormal cerebral blood flow response during the time between birth and heart surgery leads to a progressive decrease in cerebral tissue oxygenation The results support and help explain the physiological basis for recent studies that show longer time to surgery increases the risk of acquiring white matter injury.

Keywords: CHD; cerebral blood flow; neonate; timing of surgery.

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Figures

Figure 1
Figure 1
Time profiles of ScO2 (a), OEF (b), BFI (c) and CMRO2,i (d). Each thin line represents measurements for a single subject with either hypoplastic left heart syndrome (red) or transposition of the great arteries (blue). Thick lines represent linear trends derived from a mixed effects model reported in Table 2.
Figure 2
Figure 2
Left: Boxplot demonstrating preoperative hemoglobin on day of birth and on day of surgery. Right: Time profiles of SpO2. Each thin line represents measurements for a single subject with either a hypoplastic left heart syndrome (red) or transposition of the great arteries (blue). Thick lines represent linear trends derived from a mixed effects model reported in Table 3 and shaded area represents the 95% confidence interval of the model.
Video 1
Video 1
Demonstration of optical measurements of cerebral blood flow and oxygen saturation.
See this image and copyright information in PMC

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